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          <h1 class="post-title" itemprop="name headline">《牙体预备标准化操作》读书笔记02</h1>
        

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        <p>第二章 牙体预备的九大标准<br>牙体预备会出现一些问题，这些问题都可以避免。善于解决问题的人，永远比不上善于避免问题的人。15分钟之内的全冠牙体预备基本难以合格。不希望医生在患者口内练习牙体预备。推荐每天预备不超过两颗，但每一颗，每一针都要认真分析设计后操作，不可随意；否则起不到练习的作用，可能适得其反。<br>提升医生的眼力的三个工具：显微镜；数码单反相机；模式图。<br>有两个模式图至关重要，矢状面和冠状面模式图，可以使医生清楚知道何为预备后的正确形态。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0142-ytbzhyb2/01.png"><br>矢状面要点：①唇侧肩台深度：排龈线0.3-0.4mm，肩台预备后与排龈线距离不小于0.3mm；②肩台外边缘线，锐利，360°清晰、锐利且光滑连续的边缘完成线；③肩台内缘：圆钝，避免应力集中；④肩台宽度：0.8mm为常态，腭侧可减少到0.6mm；⑤唇侧轴面：由颈中切三个面顺滑组合而成，不是两个面或一个面，不能有倒凹。⑥切缘厚度，不能过薄，不能小于0.7mm。铸造类的可以薄一些。⑦舌侧窝：明显的舌侧窝，不能有倒凹，应与设计的舌侧形态平行。⑧腭侧颈袖：与唇侧颈部接近平行，但均有适合的聚合度，注意不要有倒凹，也不要追求平行，不能是折线，也不能由于轴向不断改变而预备成弧线。建议高度3mm，不能少于2mm；⑨腭侧肩台内外缘：同唇侧；⑩龈上肩台：腭侧常规为龈上肩台。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0142-ytbzhyb2/02.png"><br>冠状面要点：①肩台深度：优先考虑齐龈，注意近远中肩台深度一般应高度一致；②肩台外边缘线：同矢状面；③肩台内缘：同矢状面；④肩台宽度：稍微缩窄到0.6mm；⑤近中邻面：注意必须是一条直线，切角位置稍有圆钝；近中切角稍长于远中切角；内聚角度2°-5°，基本等同于远中；⑥切缘：一条直线，近中比远中更倾向于切方，但要注意角度适当，与设计形态相似；⑦远中邻面：注意也是一条直线，不是折线或弧线；内聚角度2°-5°，基本等同于近中。切角位置明显圆钝；⑧唇侧肩台：注意是一条弧线，不能含有任何直线。唇侧肩台弧线应与健康牙龈形态一致，外形高点同样位于正中稍偏远中。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0142-ytbzhyb2/03.png"><br>全瓷冠的预备后形态应与设计形态相似。如特殊原因预备量大，需要注明用“回切法制作内冠”，而不是常规制作的均匀内冠。减少崩瓷几率。<br>牙体预备的九大标准：<br><strong>标准一：正确的外形——车针严格定深&amp;硅胶背板双重检验。</strong><br>过多过少都不行。<br>方法：车针定深+硅胶背板。<br>若修复牙多，问题复杂：制作蜡型，mock-up后正在mock-up上备牙。修复牙少，问题较小，可用树脂直接在口内mock-up。然后再车针定深，背板检查。<br>先加后减。<br><strong>标准二：肩台宽度相对均匀一致</strong><br>窄会影响技师制作，宽则创伤大。要做到肩台360°宽度基本均匀一致。<br>方法：首选选择合适车针，车针标准化。要知道车针的直径。用车针做尺子，测量肩台宽度。初学者可以预备窄一些，然后逐渐加宽肩台。<br>(最怕打折扣，一旦打折扣，必然“此路不通”。）<br><strong>标准三：肩台的360°光滑、连续</strong><br>方法：五查，精准预备。可以将肩台分为八部分，精准调整头向，将八个部分之间不连续的部位进入切线观察，确定轴向和比例。<br><strong>标准四：清晰、锐利的360°边缘完成线。</strong><br>方法：做到车针轴向严格控制到正确的角度，并且预备同一部位的数针轴向要保持一致。车针一定要有一部分按比例悬在肩台外，否则容易产生飞边。<br><strong>标准五：全程保护牙龈</strong><br>预备前：牙周治疗，不要在牙龈炎症状态下预备牙齿和制取印模。<br>操作中，不可损伤牙龈。正确排龈。<br>一定要避免牙龈在任何一个阶段的损伤，而不是在损伤后想方设法治疗。<br><strong>标准六：全程保护牙髓</strong><br>①分析设计阶段：重点考虑牙髓保护，牙髓外1mm厚的牙本质活力核心区是否能够全部保存，是能否避免牙髓炎的一项重要因素。活髓修复一定是首选，绝不可滥用去髓修复。<br>②预备阶段，保护牙髓，避免刺激。手机喷水量足够，不要用力预备。用新车针。预备中用力过大是应着重避免的一个坏习惯，对于备牙有弊无利。活髓牙不要用气枪吹。<br>③临时修复体的精密度。应该进行认真精密的临时粘接，不能不粘接或封闭不全。<br>④在试戴过程中要保护牙髓，不要随意吹气，不能磨除牙体。选用对牙髓刺激小的粘接系统。<br>要达到的目标:预备后次日，患者牙髓无不适；粘接后次日，患者牙髓无不适。<br><strong>标准七:正确龈下肩台预备深度，轻松制取出360°龈沟</strong><br>只要在预备中注意肩台预备深度不要过深，车针保持稳定不损伤牙龈，使得牙龈保持健康，就可以轻松取出360°龈沟。<br>应该与预备牙体少、技术难度低的龈上肩台为首选。只有在美观需要、固位需要、缺损或龋坏到龈下，以上三者满足一种时，方考虑龈下肩台。固位力是完全可以被粘接替代的。<br>先备到齐龈，然后按标准进行排龈。在预备阶段，车针要离开排龈线不少于0.3MM。要切记”带线龈下预备”，并且按标准进行龈下预备。<br><strong>标准八:肩台高度抛光</strong><br>肩台抛光有助于达到很好的边缘适合性。<br>使用红标车针做肩台二次预备，用黄标车针进行肩台的抛光。也可使用釉凿，但抛光效果略差于钨钢车针。使用电动马达或涡轮机踩到最低点，用相同形状，相同尺寸的钨钢车针进行抛光。<br>肩台是否精密，用牙龈来检验。如果精密度有问题，牙龈就会存在相应程度的牙龈炎症；精密度越差，相应位置的牙龈炎症越明显。<br><strong>标准九:腰椎和颈椎的自我保护</strong><br>不能弓腰驼背，不能不用口镜只靠颈椎、腰椎的扭转，不能不调整患者椅子只用医生的颈椎、腰椎去迎合。<br>通过医师和患者椅的调整，使得医生双臂与患牙位于相同高度，调整医师椅背升到最高且内倾，使得医生后背被椅背支撑。<br>时刻体察自己的后背是否弯曲，一旦弯曲，就要调整。使用放大镜，显微镜。<br><strong>(总结:要用模式图来提高自己的眼力，我照着书在电脑上自己画的，果然画了要清楚一些。牙体预备的九大标准，可以分成几类:①形态:外形正确(mock-up，背板)，肩台宽度均匀，360°光滑连续，形成清晰锐利的360°边缘完成线。②微创:全程保护牙龈(排龈，带线操作)，全程保护牙髓(保留核心区，预备中注意牙髓保护，临时冠，粘接注意保护)。③精密:获取360°龈沟印模，肩台高度抛光。④自我保护:腰椎颈椎(体位)。)</strong></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“好看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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